Gombination Of Shunt Procedure With Portal Azygous Devascularization For Portal Hypertension

objective To investigate the clinical effects of proximal spleno-renal shunt (PSRS)combined with pericardial devascularization(PCDV) and its effects on hemodynamic of the portal venous system. Methods Through the follow-up examination of 44 cases of portal hypertension treated by PSRS+PCDV from Janugry 1990 to July 2003 in our General surgical department,some patients were adopted Doppler colour flow imaging(DCFI) and free portal pressure(FPP) which would be observed comprehensively on hemodynamic of the portal venous system preoperative and postoperative changes comparatively studied 114 cases treated by PCDV in corresponding period whose sex, age and liver function has no difference. Results There was no short term rebleeding in Group PSRS+PCDV, and the incidence of rebleeding was8.3% during a long period of follow-up. The operative mortality was 4.5%. The rate of hepatic encephalopathy was 5.5% postoperatively ,and the long term survival rate of 1,3,5 and 10-year was 97.2%,91.2%,76.0% and 64.3% respectively. There was no short-term rebleeding in Group PCDV. The operative mortality was 4.3%. The long term rebleeding rate was 13.0%. The rate of hepatic encephalopathy was 4.4%. And the postoperative surrival rate of 1,3,5 and 10-year was 96.7%,86.7%,71.8% and 56.3%. In Group PSRS+PCDV, The portal vein flow rate(PVF) and FPP respectively decreased by 511.01±151.93ml/min (33.26%±5.57%) and 8.44±3.68cmH2O (21.26%±9.10%) postoperatively comparing with preoperation (P<0.01),which still corresponded to the normal upper limit ,suggesting that the liver kept a good perfusion from the portal vein. Though FPP and PVF decreased in Group PCDV, they did not differ apparently comparing with preoperation(P>0.05). Gonclusion The arresting effect of PCDV is good with little interference on hemodynamic of the portal venous system and low rate hepatic encephalopathy. Due to neither effectively reduce FPP and PVF ,nor mitigate the state of hemorrhage on portal vein, it is easier to form new portal azygos vein and aggravate portal hypertensive gastropathy(PHG). So the weakness on high rate of long-term bleeding existed. The combined procedure not only cut down the unusual portal azygos vein and lower FPP and mitigate the state of hemorrhage on portal vein as well. It also makes the liver keep a good perfusion from the portal vein. The clinical effect was satisfactory. So the combined procedure is considered to achieve the purpose of complement each other's superiority. And it is a rational and practical operation in the treatment of portal hypertension.